HomeMy WebLinkAbout06080024 Application
City of Carmel/Clay Township Permit #: OC,oR OOOl?-(
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Multi-Family, &. Two Family: New Structures, Additions, Remodels, &. Accessory Structures
NAME
PHONE
FAX
/y6- yay
BUILDER of
RECORD:
STREET ADDRESS
C(2)-
PROPERTY
OWNER:
NAME
STREET ADDRESS
LOCATION
&. PROJECT
INFO:
LOT #
Yo
SEWER UTILITY
PROVIDER:
ADDRESS OF CONSTRUCTION.c1 --- d
",L~ :z VI <-I< A.-Yt
WATER UTILIlY /' 0,"0 ~ 00 d. '>
PROVIDER: L.::LA r>1t'(
ESTIMATED COST OF CONSTRUCTION: .q
(EXCLUDING LAND VALUE) ..-<- l' J t7 tJ 0, U 0
C7;r <A.JO
NAME OF UTILITY EXCAVATION CONTRACTOR; PLAN COMMISSION / BZA / BPW DOCKET
NUMBERS; TAC DATE(S); AND/OR. COUNTY WELL AND/OR SEPTlC PERMIT #'5 (IF APPLICABLE):
TY;::{A:ONSTRUCTION:
SINGLE FAMILY
o TOWN HOME
o TWO FAMILY
# of units:
o MULTI-FAMILY
# of Units:
o RESIDENTIAL (For
Additions, Remodels, Etc.)
TY~ .IMPROVEMENT:
NEW STRUCTURE
o ROOM ADDmON(S)
o PORCH ADDmON(S)
o REMODEL
o ACCESSORY BUILDING
o DETACHED GARAGE
o ATTACHED GARAGE
o DEMOLITION
e/</IJ.I<-
PLUMBING CONTRACTOR:
- /5 t-<
'\
0) 0 ~
~
Which plumbing codes will be applied to the construction: '\
C9-1iitemational Residential Code w!Indiana Amendments
o Uniform Plumbing Code w/Indiana Amendments
(Multi-Family Construction Code)
PROJECT INFORMATION:
Early Release Manufactured /' FOUNDATION TYPE: (Check all that apply for the new
~ construction area)
Permit: - Y _N Trusses: - y~N 0 CI3I'WLSPACE 0 ~& BEAM
Lot Split: _Y _N Sump Pump: ~ _N ~LAB c:rBASEMENT
Does any part of the prope ~d designation area: Y N WALKOUT: Y
,For Single Fa~!i,an .TlY.Pt(WHffiWMtd~t~naa~. and/or accessory structures, this permit is valid only if construction commences
within 180 d~gjW(J- ~~tc.p.Ufr~tn59.....q5~ ~~.permit. and must be completed (Certificate of Occupancy issued) within 18 months of the
issuance date. Class I st~tlil't'p~r\l{its arr.~~""q:.l>l>.5~dministrative Rules of the State of Indiana (See 675 lAC 12) regarding expiration
~PT OF- CO M M U N Illihe~Uo ffi'/llling and completing constructioo.
I, the undersi~<<;< r?\~~nAA_C '~~~"ifQ ,iiylfuent, relocation, or alteration of a structure, or any change in the use of land or
structures reqtWle ~s Jp'pIl~~tidn ly with, and conform to, all applicable laws of the State of Indiana, and the "Zoning Ordinance of Carmel
Indiana -1993" (Z~289) and amendmJ nder authority of r.c. 36~7 et seq, General Assembly of the State of Indiana, and all Acts amendatory
thereto. I furrher cerrify that only kitchen, bath, and floor drains are connected to the sanitary sewer. I further certify that the construction will not be
used or OCC7'd"ilicace of Occupancy has been Issued)2? D'(a:tmG oRo~mu~ervlces. Carmel. Indlaoa j -2 _ (}.{,
S ature of Owner or Authoriz ~ I ~ Date
~
OFFICE USE ONLY: *********************************************~*************************
Filing Fees: /dO' 0 ()
INSPECTIONS REQUIRED: -; 7 7. </1
Base Inspections: =-- _._ -1!..L
nder Slab
Cert. of Occupancy:S3 . >,0
I c2-G I 00
/' c2~/~. ()()
.- 9-03
# Charged Re-
Reviews
Site
P.R.I.F.:
Additional Fees
c \(7}... "~"S-t.<- 8-1-'l>6
ReviewedfAppr ved: Dept. of Community Services (Date)
S:PermitsjFormS/ILP RESIDENTIAL
Fee Rec ived by: